Healthcare Provider Details

I. General information

NPI: 1538330063
Provider Name (Legal Business Name): HOUCHENS EXPRESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 CAMPBELL LN STE 121
BOWLING GREEN KY
42104-1085
US

IV. Provider business mailing address

843 FAIRVIEW AVE
BOWLING GREEN KY
42101-4914
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-6337
  • Fax: 270-783-4272
Mailing address:
  • Phone: 270-842-4515
  • Fax: 270-842-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07332
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LESLIE BIDWELL
Title or Position: OPERATIONS COORDINATOR
Credential:
Phone: 270-901-3431